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U.S. children are more likely to live apart from a biological parent than at any time in history. Although the Child Support Enforcement system has tremendous reach, its policies have not kept pace with significant economic, demographic, and cultural changes. Narrative analysis of in-depth interviews with 429 low-income noncustodial fathers suggests that the system faces a crisis of legitimacy. Visualization of language used to describe all forms child support show that the formal system is considered punitive and to lead to a loss of power and autonomy. Further, it is not associated with coparenting or the father–child bond—themes closely associated with informal and in-kind support. Rather than stoking men’s identities as providers, the system becomes “just another bill to pay.” Orders must be sustainable, all fathers should have coparenting agreements, and alternative forms of support should count toward fathers’ obligations. Recovery of government welfare costs should be eliminated. (Author abstract)

U.S. children are more likely to live apart from a biological parent than at any time in history. Although the Child Support Enforcement system has tremendous reach, its policies have not kept pace with significant economic, demographic, and cultural changes. Narrative analysis of in-depth interviews with 429 low-income noncustodial fathers suggests that the system faces a crisis of legitimacy. Visualization of language used to describe all forms child support show that the formal system is considered punitive and to lead to a loss of power and autonomy. Further, it is not associated with coparenting or the father–child bond—themes closely associated with informal and in-kind support. Rather than stoking men’s identities as providers, the system becomes “just another bill to pay.” Orders must be sustainable, all fathers should have coparenting agreements, and alternative forms of support should count toward fathers’ obligations. Recovery of government welfare costs should be eliminated. (Author abstract)

Background: Child maltreatment is a pressing social problem in the USA and internationally. There are increasing calls for the use of a public health approach to child maltreatment, but the effective adoption of such an approach requires a sound foundation of epidemiological data. This study estimates for the first time, using national data, total and type-specific official maltreatment risks while simultaneously considering environmental poverty and race/ethnicity. Methods: National official maltreatment data (2009–13) were linked to census data. We used additive mixed models to estimate race/ethnicity-specific rates of official maltreatment (total and subtypes) as a function of county-level child poverty rates. The additive model coupled with the multilevel design provided empirically sound estimates while handling both curvilinearity and the nested data structure. Results: With increasing county child poverty rates, total and type-specific official maltreatment rates increased in all race/ethnicity groups. At similar poverty...

Background: Child maltreatment is a pressing social problem in the USA and internationally. There are increasing calls for the use of a public health approach to child maltreatment, but the effective adoption of such an approach requires a sound foundation of epidemiological data. This study estimates for the first time, using national data, total and type-specific official maltreatment risks while simultaneously considering environmental poverty and race/ethnicity. Methods: National official maltreatment data (2009–13) were linked to census data. We used additive mixed models to estimate race/ethnicity-specific rates of official maltreatment (total and subtypes) as a function of county-level child poverty rates. The additive model coupled with the multilevel design provided empirically sound estimates while handling both curvilinearity and the nested data structure. Results: With increasing county child poverty rates, total and type-specific official maltreatment rates increased in all race/ethnicity groups. At similar poverty levels, White maltreatment rates trended higher than Blacks and Hispanics showed lower rates, especially where the data were most sufficient. For example, at the 25% poverty level, total maltreatment report rates were 6.91% [95% confidence interval (CI): 6.43%–7.40%] for Whites, 6.30% (5.50%–7.11%) for Blacks and 3.32% (2.88%–3.76%) for Hispanics. Conclusions: We find strong positive associations between official child maltreatment and environmental poverty in all race/ethnicity groups. Our data suggest that Black/White disproportionality in official maltreatment is largely driven by Black/White differences in poverty. Our findings also support the presence of a ‘Hispanic paradox’ in official maltreatment, where Hispanics have lower risks compared with similarly economically situated Whites and Blacks. (author abstract)

Objectives. To explore the effect of Medicaid expansion on US infant mortality rate.

Methods. We examined data from 2010 to 2016 and 2014 to 2016 to compare infant mortality rates in states and Washington, DC, that accepted the Affordable Care Act Medicaid expansion (Medicaid expansion states) and states that did not (non–Medicaid expansion states), stratifying data by race/ethnicity.

Results. Mean infant mortality rate in non–Medicaid expansion states rose (6.4 to 6.5) from 2014 to 2016 but declined in Medicaid expansion states (5.9 to 5.6). Mean difference in infant mortality rate in Medicaid expansion versus non–Medicaid expansion states increased from 0.573 (P = .08) in 2014 to 0.838 in 2016 (P = .006) because of smaller declines in non–Medicaid expansion (11.0%) than in Medicaid expansion (15.2%) states. The 14.5% infant mortality rate decline from 11.7 to 10.0 in African American infants in Medicaid expansion states was more than twice that in non–Medicaid expansion states (6.6%: 12.2 to 11.4; P = .012).

Conclusions....

Objectives. To explore the effect of Medicaid expansion on US infant mortality rate.

Methods. We examined data from 2010 to 2016 and 2014 to 2016 to compare infant mortality rates in states and Washington, DC, that accepted the Affordable Care Act Medicaid expansion (Medicaid expansion states) and states that did not (non–Medicaid expansion states), stratifying data by race/ethnicity.

Results. Mean infant mortality rate in non–Medicaid expansion states rose (6.4 to 6.5) from 2014 to 2016 but declined in Medicaid expansion states (5.9 to 5.6). Mean difference in infant mortality rate in Medicaid expansion versus non–Medicaid expansion states increased from 0.573 (P = .08) in 2014 to 0.838 in 2016 (P = .006) because of smaller declines in non–Medicaid expansion (11.0%) than in Medicaid expansion (15.2%) states. The 14.5% infant mortality rate decline from 11.7 to 10.0 in African American infants in Medicaid expansion states was more than twice that in non–Medicaid expansion states (6.6%: 12.2 to 11.4; P = .012).

Conclusions. Infant mortality rate decline was greater in Medicaid expansion states, with greater declines among African American infants. Future research should explore what aspects of Medicaid expansion may improve infant survival. (Author abstract)

The mathematics of poverty suggest that family composition changes may influence poverty rates and, in particular, that the addition of a new child increases estimated family expenses and correspondingly the family’s poverty threshold. This analysis of 2015 Current Population Survey data finds that those families more likely to live in poverty—Black and Hispanic families, families with children, less-educated families, and those living in more rural or highly urban environments—are at heightened risk of falling into poverty with an additional child. (Author abstract)

The mathematics of poverty suggest that family composition changes may influence poverty rates and, in particular, that the addition of a new child increases estimated family expenses and correspondingly the family’s poverty threshold. This analysis of 2015 Current Population Survey data finds that those families more likely to live in poverty—Black and Hispanic families, families with children, less-educated families, and those living in more rural or highly urban environments—are at heightened risk of falling into poverty with an additional child. (Author abstract)

In recent years, the big news in Social Security reform has been the program’s fiscal concerns. In light of concerns about both program costs and benefit adequacy, we propose an effective and relatively inexpensive targeted program to provide a minimally adequate floor to old-­age income through the Social Security system. This minimum benefit plan would provide a cost-­effective method for reducing elder poverty to very low levels. A key element is that the benefit would not count toward income eligibility thresholds for other social programs. Other aspects include an income-­tested benefit that would bring beneficiaries to 100 percent of the poverty threshold; application by filing of a 1040 income tax return; and setting of benefit levels and distribution through the Social Security Administration. (Author abstract)

In recent years, the big news in Social Security reform has been the program’s fiscal concerns. In light of concerns about both program costs and benefit adequacy, we propose an effective and relatively inexpensive targeted program to provide a minimally adequate floor to old-­age income through the Social Security system. This minimum benefit plan would provide a cost-­effective method for reducing elder poverty to very low levels. A key element is that the benefit would not count toward income eligibility thresholds for other social programs. Other aspects include an income-­tested benefit that would bring beneficiaries to 100 percent of the poverty threshold; application by filing of a 1040 income tax return; and setting of benefit levels and distribution through the Social Security Administration. (Author abstract)